School Module Sign up Form

Thank you for your interest in our programme.
Note that filling in the form below does not guarantee you a space on the programme as we will prioritise schools with the most Widening Participation indicators. To see a list of our indicators please check our website.

Schools will be contacted at the end of November to confirm their place.

SCHOOL DETAILS

School Name:
*

Main Contact Title
*

Main Contact First Name
*

Main Contact Surname
*

Main Contact Role
*

Main Contact Email
*

Main Contact Phone
*

CLASS DETAILS

Year group
*

Group size (maximum 40)
*

Our Year 5 class is available on Wednesday afternoons on the date below
*

Please indicate the exact times you would like the ambassadors to start and stop teaching your class
*

Our class and teacher can attend the Evening Graduation Ceremony on 6th March 2019
*

Yes

No

MODULE

This year, we have two modules on offer.

Preferred module
*

* indicates a required field

Privacy statement

This form will be used to manage your participation to our programme. Your participation and attendance at the events will be recorded and associated with your name and school, but no other personally identifiable data will be stored, and the data will not be used for any purpose other than as a record of your participation.

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